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The Year of Ultrasound Brings Implementation and Innovation

Published on the June 24, 2013, DiagnosticImaging.com website

By Whitney L.J. Howell

Ultrasound isn’t a new tool, and it’s little secret this imaging method provides invaluable studies without the use of radiation. But now there are enough advancements and technological changes to the modality to capture the industry’s attention all over again.

In fact, the American Institute for Ultrasound in Medicine (AIUM) has dubbed 2013 the “Year of Ultrasound.” The goal: increasingly integrate ultrasound education and use throughout all levels of health professions education and clinical application.

But, why?

Many practitioners in the field point to the warning bells in recent years calling for even more vigilance in restricting radiation exposure in adults and children. These concerns have led to the ALARA — As Low As Reasonably Achievable — principle and the Image Wisely and Image Gently campaigns. However, it’s more than that, said Leann Linam, MD, a pediatric radiologist at Arkansas Children’s Hospital.

“One of the beautiful things about ultrasound imaging is its lack of radiation, but there’s also been a huge push for other specialties to get involved with ultrasound,” she said. “Giving other providers a portable imaging modality that can be done at the bedside is a major reason why this is the Year of Ultrasound.”

According to Michael Blaivas, MD, AIUM’s third vice president and president of

Michael Blaivas, MD, AIUM’s third vice president and president of the Society of Ultrasound in Medical Education

the Society of Ultrasound in Medical Education, the industry is also seeing a rapid expansion in the functionality ultrasound is able to offer throughout the healthcare system.

The Focus on Ultrasound

Ultrasound’s popularity has steadily grown, Blaivas said, making it a commonly used tool in a plethora of specialties and subspecialties over the past few decades. The wider use is a positive step, he said, but the most encouraging development has been the increase in number of medical school – and other health professions – curricula that now offer ultrasound instruction throughout all years of training.

“We’re seeing ultrasound adopted in every specialty now as the standard of care. From A to Z, with the exception of pathology and psychology – it’s being used across the gamut. For many things in the emergency department to standard use for central line placement,” Blaivas said. “There’s also a significant groundswell for use by nurses and physicians assistants.”

In fact, he said, 2013 has been the biggest year for raising awareness of the benefits ultrasound offers – mainly the lack of radiation, lower cost than other modalities, and comparable image quality.

Ultimately, he said, this increased education could one day enable providers to offer more focused diagnoses throughout body systems and could play a significant role in image-guided procedures. Using ultrasound in that fashion could make invasive procedures faster and safer.

Not everyone in the global radiology community is wholly comfortable with non-radiologists performing ultrasounds, however. There is a significant portion of radiologists who oppose the practice altogether, but a small faction support it because they believe it ensures a low-cost, high-quality imaging service will be available to more patients, said Levon Nazarian, MD, a musculoskeletal radiologist at Jefferson University Hospitals and editor-in-chief of the AIUM’s Journal of Ultrasound in Medicine.

“There are radiologists who resent any imaging being done by other specialties. Their main concerns are quality and economics — they don’t like the idea of someone taking over their turf,” he said. “The second, though smaller, camp is filled with people want to see ultrasound better utilized to deliver high-quality imaging and guided interventions to patients. The thought is that it would mean better healthcare for all.”

There is a sticking point, however, he said. The need for ultrasound interpretation in all fields, especially obstetrics and sports medicine, is far greater than the current number of providers can sift through. And many, he added, have little interest or expertise is conducting these studies. The solution, he said, is to open the door for other specialties to offer ultrasound as long as practitioners receive the proper training despite pushback from industry leaders and experts.

In fact, in February 2012, the Royal College of Surgeons in Ireland published a statement in support of allowing properly-trained non-radiologists to perform ultrasounds.

What’s Next for Ultrasound?

Although ultrasound is an increasingly popular modality in the United States, providers still underutilize it, Blaivas said. Elsewhere in the world, however, radiologists are already using ultrasound for more extensive chest and abdominal imaging.

For example, European providers for the past decade have been expanding the use of lung ultrasound in the diagnosis of pneumonia and pulmonary edema. Other radiologists in Asia have begun using ultrasound to image the abdomen, successfully identifying incidences of appendicitis and gastrointestinal reflux. Historically, he said, American providers have opted to use CT in these situations.

“In many cases, ultrasound is far more sensitive and better than chest CT, and it certainly pales in comparison to the cost of CT,” Blaivas said. “Not to mention, it’s portable and can be done at the bedside, giving us greater opportunity to evaluate our most critically-ill patients.”

In fact, he said, the next technological milestone for ultrasound will likely benefit critical and emergency patients the most. Vendors are currently shrinking the machines down to the size of a smartphone, such as the GE VScan. Improved functionality and better image quality will likely follow in subsequent generations.

European radiologists are also beginning to use contrast agents with ultrasound as a way to enhance image quality and improve information gathering, Linam said. Known as microbubbles, these contrast agents are gas-filled and are administered intravenously. They’re highly sensitive and easily reflect ultrasound waves off the body’s soft tissues. Currently, microbubble contrast is only being used as a research method in the United States, she said, but internationally, providers already use it clinically to image blood perfusion in organs and to measure blood flow rate in the heart.

Who am I?

I’m a seasoned reporter, writer, freelancer and public relations specialist with a master’s degree in international print journalism from The American University in Washington, D.C.

I launched my journalism career as a stringer for UPI on Sept. 11, 2001, on Capitol Hill. That day led to a two-year stint as a daily political reporter in Montgomery County, Md. As a staff writer for the Association of American Medical Colleges, a public relations specialist for the Duke University Medical Center and the public relations director for the UNC-Chapel Hill School of Nursing, I’ve earned in-depth experience in covering health care, including academic medicine, health care reform, women’s health, pediatrics, radiology, and Medicare.